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Family
Assistance Center

The establishment of a family
assistance center is necessary to facilitate the exchange of information
and to address the families needs. Families and friends may spend
many long hours waiting anxiously for information about their loved ones.
The family assistance center provides the families with accurate information
in an appropriate manner and setting.

Many families travel to the disaster site
and are away from home for some time. Other families are displaced as
a result of the disaster. The family assistance center addresses the basic
physical needs, including food, shelter, transportation, telephones, and
emergency services, that these families often will have.

When a community develops a crisis response
plan, it is essential that county and state victim assistance and compensation
staff collaborate to ensure that the family assistance center has information
about community resources such as mental health support, spiritual counseling,
grief support, and childcare. Then, in the event of disaster, an effective
family assistance center can be established quickly. The Oklahoma City
family assistance center, the Compassion Center, was in operation by 3:30
p.m. on the day of the bombing.

The Compassion Center was initially set up
by the Office of the Chief Medical Examiner. The Oklahoma Funeral Directors
Association provided about 20 funeral directors to greet families and
gather antemortem (predeath) information.2By
the next day, April 20, the American Red Cross was operating the Compassion
Center and serving victims and families. Hundreds of local clergy, police,
military chaplains, and mental health professionals from across the Nation
supported the Compassion Center. Other agencies also shared support responsibilities
for the Compassion Center, including the County Sheriffs Office,
the Oklahoma National Guard, the Salvation Army, Tinker Air Force Base,
and the Department of Veterans Affairs.

The effective operation of a family assistance
center like the Compassion Center depends on many organizations and individuals
working together as a team, the establishment of a chain of command, and
the selection of a site that is acceptable to all the individuals and
agencies that will be working there. Commitment and coordination by all
involved in the establishment of a family assistance center will enhance
the rescue and recovery effort.

The following text discusses the considerations
and factors involved in selecting a site for the family assistance center
and in establishing policies and procedures that will ensure that the
work of the family assistance center is effective.

Many factors must be considered when selecting
a site for a family assistance center. The type of disaster event and
number of fatalities will affect site selection. A family assistance center
should be located close enough to the site of the disaster to allow the
medical examiner or coroner and others to travel easily among the site,
morgue, and center but far enough from the site that families are not
continually exposed to the scene. If available, a neutral, nonreligious
site such as a hotel or school is often an ideal choice for a family assistance
center because some families may be uncomfortable coming to a religious
structure. In addition, a hotel or school often can provide flexible,
long-term accommodations. Finally, those involved in site selection should
keep in mind the many agencies that are part of that communitys
crisis response plan and consider what those agencies will need to do
their jobs effectively.

Availability
of FacilityImmediate and Long Term

The family assistance center should be established
and opened as soon as possible after the incident. The center may be needed
for as long as 34 weeks, depending on the length of time necessary
to recover the bodies. In Oklahoma City, the site was selected and the
Compassion Center was available to the victims friends and families
immediately after the bombing. The massive destruction of the building
made recovery of the bodies difficult and slow. The Compassion Center
was open and operating for 16 days, until the last body was recovered.
Other large-scale events may require additional resources, including mental
health care. More information about crisis response
planning appears later in this bulletin.

Infrastructure

The infrastructure of the site under consideration
for the family assistance center must meet several requirements. It is
very important to estimate the number of family members and friends who
may visit the center to determine whether the centers infrastructure
is adequate to handle that number of people. The structure must offer
adequate services and utilities including electrical power, telephone
service, toilets, controlled heat and air conditioning, water, and sewage.
A determination must be made about whether the site can accommodate people
with disabilities. In addition, a suitable site must allow for implementation
of security measures. Information about procedural
considerations appears later in this bulletin.

The First Christian Church in downtown Oklahoma
City was selected as the Compassion Center because of the buildings
proximity to the bombing site, size and floor plan, food service facilities,
and adequate parking spaces for about 1,200 vehicles. The bombing resulted
in 168 fatalities. As many as 1,200 family members and friends were at
the Compassion Center at one time, especially during the first days following
the bombing. The Compassion Center did not need to include overnight facilities
because the Oklahoma City bombing was a local event.

Space and
Floor Plan

The family assistance center needs to have
a floor plan that will accommodate the simultaneous and effective performance
of many functions for and delivery of services to the families and friends
of the victims.

Operations center and administrative offices.
An operations center is necessary to allow the different service
groups and organizations to meet. If representatives from all organizations
are present at meetings, then victim services can be coordinated and efforts
will not be duplicated. In addition, administrative offices should be
available for all of the different service groups including mental health
professionals, clergy, and medical examiners and organizations including
the American Red Cross and Salvation Army. Since these administrative
offices will hold files and confidential information generated by the
family assistance center, they must be kept secure. It could be devastating
to the victims families if information about their loved ones was
leaked before the families were properly notified. Controlling how, when,
and where official death notification information is released minimizes
confusion and helps staff avoid problems. Later, this bulletin discusses
the concerns related to releasing search, recovery, and
death notification information to the families and the press and describes
the procedures that Oklahoma City adopted. Finally, the family assistance
center should have a separate entrance for its staff so they can check
in, be briefed, and receive their assignments before they interact with
the families.

General assembly room. A large room
with a public address system should be available so that updates on the
search and recovery process can be given at least twice daily to large
gatherings of family members and friends. Activities in this room may
require translator services, including sign language interpretation. In
large cities, possible sources for translators include a local consulate,
embassy, or the U.S. Department of State. For more information about such
services, contact a local federal agency, university, hospital, or judicial
system or court.

Reflection room. The family assistance
center should provide a space where the victims families and friends
can quietly reflect, meditate, pray, seek spiritual guidance, or observe
religious practices. This space must be designed and furnished to respect
diverse cultures and beliefs. The family assistance center made such a
space available after the October 31, 1999, EgyptAir Flight 990 crash
into the Atlantic Ocean 60 miles south of Nantucket Island, Massachusetts.

Death notification rooms. To provide
privacy and to expedite the notification process, several rooms should
be set aside for families to receive the information that their loved
ones have been identified. Circumstances may dictate how death notification
takes place. In Oklahoma City, families were asked to return to the Compassion
Center to receive the death notification of their loved ones. Some families
felt retraumatized when asked to return to the Compassion Center because
they knew that this request was made so that they could be given the official
death notification. In most cases, it is preferable for death notification
teams to be sent to the families homes rather than requiring families
to come to the family assistance center. The Oklahoma City Medical Examiners
Office coordinated with organizations such as the military and the police
departments that sent their own personnel to the families homes
to carry out death notification.

Counseling rooms. Several small rooms
should be available to provide a private space where information such
as antemortem data can be gathered from families and where families can
receive counseling from clergy and mental health professionals. In addition,
these rooms can be used for family members to spend time together and
to use the telephone to contact other relatives and friends. The number
of rooms necessary will vary depending on the number of fatalities. The
following is a general rule: 100 or fewer fatalities will require 35
rooms, 101200 fatalities will require 1012 rooms, and more
than 200 fatalities will require 1525 rooms. Counseling that is
meant to convey positive identification of the loved one and emotional
support for families should not be conducted in hotel rooms with bedroom
furniture. If hotel rooms are the only rooms available, replace the bedroom
furniture with couches and chairs.

Medical area. Family members and
friends of the victims may require medical assistance. In Oklahoma City,
the Compassion Center provided an area that had eight beds and was staffed
with registered nurses, paramedics, and doctors. For the first 3 or 4
days, this medical area was very busy caring for the medical problems
of family members, friends, and Compassion Center workers. In addition,
an ambulance was on standby at all times at the Compassion Center to transport
patients to area hospitals if necessary.

Reception and registration for families.
When family members and friends
arrive at the family assistance center, the staff should greet them and
gather information about who will be visiting the family assistance center.
Staff will assign them an escort who will take them to a designated area
where they may be more comfortable and can be located if necessary. When
families and friends leave the family assistance center, they should check
out and leave their address so that they can be contacted with additional
information and support and notification of their loved ones deaths.
When adequate personnel are available, an escort may be assigned to each
family group. Escorts may help the families with any need that arises
during their stay at the family assistance center. At the Oklahoma City
Compassion Center, the American Red Cross provided personnel who were
trained in counseling to serve as escorts.

Collect antemortem data. Personnel
at the family assistance center will be assigned to collect accurate and
detailed antemortem information from the families and friends of the victims.
This information may be gathered by experienced death investigators or
funeral directors who have been well briefed on the information they need
to collect from the families. If funeral directors are providing this
service, it is critical that they act as representatives of the medical
examiners or coroners office and not as funeral directors.
In Oklahoma City, funeral directors acted as representatives of the Medical
Examiners Office in gathering antemortem information. Funeral directors
were selected to perform this service for many reasons, including their
training in collecting antemortem information and their experience in
dealing with families in crisis. However, they were told that they must
act as representatives of the Medical Examiners Office.

Death certificate information can be collected
at the initial interview to save the families from going through another
interview at the funeral home. Many states require that similar information
be provided on death certificates, including the deceaseds occupation,
level of education, and residency and the name of the informant (person
providing the information). During an investigation, NTSB uses another
form, the National Disaster Medical Systems Disaster Mortuary Operational
Response Team (DMORT) questionnaire form, which DMORT developed as a universal
questionnaire designed to expedite antemortem data collection. Before
conducting antemortem interviews, NTSB compares the information on the
state death certificate with the information on DMORTs Family Assistance
Center (FAC) Questionnaire and then requests any missing information.
DMORTs 7-page FAC Questionnaire can be downloaded from the DMORT
Web site at www.dmort.org by clicking
FAC
Questionnaire. During antemortem data collection, it is important
to reassure families that all information will remain confidential.

The U.S. Department of Health and Human Services
(HHS), DMORT, and the Disaster Medical Assistance Team (DMAT) are resources
that medical examiners and coroners can draw on to assist with victim
identification and provide medical services. (See DMORT contact
information at the end of this bulletin.) In a major criminal event,
the FBI will be involved, and its disaster squad can assist the medical
examiner or coroner by providing fingerprint experts. The American Red
Cross can assist the medical examiner or coroner by providing mental health
professionals who may be needed during antemortem interviews or memorial
services. Victim advocates can identify community resources and refer
the victims families to them for help throughout the recovery process.

Conduct death notifications. The
procedures for death notification are an important component of a sensitive
family assistance plan. Whenever possible, death notification should be
made by a team rather than an individual. The team may consist of a representative
of the medical examiner or coroner, a member of the clergy, a mental health
professional, and possibly a medical professional. Some families may feel
a notification team is not necessary, but other families may need the
support. It is better to err on the side of having support persons present
in case they are needed than to need them and not have them present. If
the familys own pastor or other clergy member is present, the team
clergy should play only a supportive role. The notification team should
be well briefed on the information being provided to the families so they
can answer as many questions as possible. The team should be given a fact
sheet that contains relevant information that they can leave with the
family for later reference, because family members may forget to ask questions
at the time of the notification.

Death notification teams also should be available
to travel to meet with families who do not want to or are not physically
able to come to the family assistance center. Next of kin who are out
of town should always be notified in person. When a death notification
must be made in a distant location, the office charged with death notification
responsibilities can contact the sheriff or chief of police in the distant
community to request coordination of notification. The American Red Cross
or the state VOCA victim assistance agency can assist in providing a mental
health professional. The office charged with death notification responsibilities
can provide the notifying law enforcement agency with a letter from the
medical examiner or coroner that contains information about the deceased
and the name and contact number for the medical examiner or coroner in
case the family has questions.

In Oklahoma City, the team approach was used
to notify families. The teams were prepared to answer questions and assist
families with any needs they had, including transportation, funeral arrangements,
and spiritual and mental health counseling. Families were advised about
unidentified human tissue. They were told about the bombs violent
impact and the resulting presence of unidentified human tissue. They were
informed that they would be notified later about a memorial service and
burial of the common tissue. Families also were told that the name and
age of their loved ones would be released to the press. They were asked
how long they needed to notify the rest of their family and friends before
that information was released to the media.

Staff conducting a death notification for
a victim whose body is not intact must ask the family at the time of notification
if they want to be informed about later identification of common tissue.
Informing the family later about common
tissue identification without their consent may be upsetting to them once
they have buried their loved one. Families may prefer to be notified only
about the memorial service and burial of the common tissue. After the
family members make their decision, staff should provide them with a written
copy of their decision as a reference for what they agreed to at that
time.

Coordinate and manage many volunteers.
In Oklahoma City, thousands of volunteers turned out to help in the
recovery effort, but they needed to be screened and directed. While preventing
the entry of unauthorized persons,3
Compassion Center staff admitted and processed thousands of volunteersscreening
credentials, examining documents, completing forms, and assessing experience
and specialized training. The task of providing appropriate victim services
for an event of this scope and nature was very difficult. The American
Red Cross Web site provides the Guide
to Organizing Neighborhoods for Preparedness, Response, and Recovery,
which offers several ideas about volunteer management and support services
for disaster preparedness. This site also helps communities identify their
own resources and teaches them how to avoid pitfalls as they develop a
crisis response plan.

Determine fiscal responsibility for expenses.
The expense of setting up the investigation site and providing family
assistance accommodations varies depending on the event and the state
in which it occurred. If the President of the United States declares the
event a disaster, the Federal Emergency Management Agency (FEMA) is immediately
contacted. FEMA provides consequence management that involves
emergency management to save lives, protect property, restore government
services, and provide emergency relief. It also funds a crisis counseling
program that is carried out through the Center for Mental Health Services.
In the event of a major transportation accident, the medical examiner
or coroner for the locality in which the accident occurred is contacted
within an hour of the accident. NTSB discusses with the medical examiner
or coroner the capabilities and resources of the local office. If the
medical examiner or coroner believes the operation is beyond local capabilities,
HHS and DMORT can provide support services. Generally, NTSB assumes investigative
expenses, and the airline involved assumes the expenses to shelter and
care for the families, including flying relatives to a location near the
site, and the victim identification costs, including DNA analysis. The
American Red Cross manages and coordinates volunteer and support services
to provide disaster relief for victims that addresses basic human needs,
including shelter, food, and health and mental health services. The American
Red Cross also feeds emergency workers, provides blood and blood products,
and helps locate other resources for those affected by the disaster.

Dispose of common tissue. After incidents
such as high-impact aviation crashes, bombings, and tornadoes, some human
tissue may not be identifiable. When the medical examiner or coroner determines
that all means of identification have been exhausted, the decision about
the disposition of common tissue must be made. Typically, common tissue
is interred at a memorial service to which the victims families
are invited. In a major aviation accident, the American Red Cross is the
designated planning organization for memorial services and may also assist
the medical examiner or coroner.

In Oklahoma City, burial arrangements for
the common tissue were complicated because, at that time, the bombing
was the largest mass murder in the Nations history, and a burial
could not take place until after the federal trials. The families were
consulted about the selection of the burial site, type of service, and
memorial marker. After 4½ years, the common tissue was buried on the
grounds of the Oklahoma State Capitol in a nondenominational memorial
service.

NTSBs Office of Family Affairs developed
a promising practice for handling the unidentified remains of victims.
They notify families that a memorial service will be held at a later date
to honor these final remains. In the case of the EgyptAir crash, a stone
was erected for the victims at the 1-year anniversary of the crash, and
flowers were dropped into the sea by the Coast Guard in honor of the victims.
Bricks, one for each victim, led to the memorial site. Each brick had
been inscribed with the name of a victim. A similar ceremony was held
for the families of the victims of the Alaska Air crash. As in the case
of the Oklahoma City bombing and many airplane crashes, interment of common
tissue may not occur soon after the mass-fatality event due to the length
of time required to complete the scientific identification of the tissue
and/or the length of time required to investigate and complete legal proceedings.

Establish victims suffering.
The issue of victims suffering can cause tension. On the one hand,
there is a need to preserve evidence that establishes the amount of suffering
the victim endured for use at the perpetrators sentencing hearing.
On the other hand, there is great need to comfort families and answer
their questions about how much their loved ones suffered before dying.
During the recovery of bodies, the medical examiner or coroner must sensitively
convey information to families that is consistent with the information
provided to the prosecution.

Implement security measures. Access
to the family assistance center must be controlled so families and friends
of the victims have privacy and are not overwhelmed by the press, photographers,
and the public. Checkpoints may need to be established at entrances to
the family assistance center and its parking lot. A badging system can
be implemented that gives family members and authorized workers easy access
to the family assistance center. The American Red Cross has a badge system
that simplifies the process of signing in and out.

In Oklahoma City, uniformed sheriffs
deputies and members of the National Guard were stationed at the outside
entrances to the Compassion Center to check identification. Also, police
in plain clothing patrolled inside the center to ensure that no unauthorized
persons gained entry.

Work with the media. The medical
examiner or coroner should designate a public information officer to release
information about the mass-fatality event. The press will have questions
that only a representative of the medical examiners or coroners
office can answer properly, including questions about the recovery operation,
identifications, and condition of the bodies. Information must be released
to the press only by the designated public information officer
and not by any staff members of the medical examiners or coroners
office. A joint information center should be set up to coordinate the
release of information, and no information should be released to the media
unless it has been discussed with the families first.

In Oklahoma City, the director of operations
for the Medical Examiners Office released information to the press
twice a day, including the names of those who had been identified as being
among the dead. The director also tried to answer all press questions
concerning the operation of the Medical Examiners Office.

In Oklahoma City, the media persistently
and intensely requested interviews with city, state, and federal officials,
survivors, family members, and rescue workers. Consequently, the Joint
Information Center (JIC) was established on April 23, 1995, to monitor
print and broadcast media, disseminate information, answer inquiries,
and assist officials in scheduling interviews. JIC operated in coordination
with the following agencies and organizations: the local U.S. Attorneys
Office; U.S. Department of Justice; Small Business Administration;
the FBI; Bureau of Alcohol, Tobacco and Firearms; Social Security
Administration; General Services Administration; Federal Executive
Board; Governors
Press Office; state departments of insurance, mental health, and human
services; State Highway Patrol; State Bureau of Investigation; State
Medical Examiners Office; American
Red Cross; United Way; and Feed the Children.4In
addition to coordinating media communications, JIC made it possible
for many diverse agencies and organizations to speak with one voice,
reducing public confusion over policies and resources. For example,
it was established that when a familys representative indicated
that the family wished to speak to the press, the public information
officer from the American Red Cross would always coordinate it.

The press served several important functions
as it covered the Oklahoma City bombing and recovery effort. It focused
world attention on this most tragic event. The press also identified victim
services and provided information to citizens who wanted to contribute
toward victim assistance.